Table 2. Estimated Health Gains and Costs of the US Food and Drug Administration’s Added-Sugar Labeling on Reducing Cancer Burdens in the US Over 12 Years and a Lifetimea.
| Parameter | Added-sugar labeling policy, median (95% UI) | |||
|---|---|---|---|---|
| 12 Years | Lifetime | |||
| Consumer Behavior | Consumer behavior + industry response | Consumer behavior | Consumer behavior + industry response | |
| New cancer cases averted, No. | ||||
| Endometrial | 1530 (957 to 2280) | 3270 (2360 to 4350) | 6240 (3500 to 9500) | 15 400 (10 900 to 20 300) |
| Breast (postmenopausal) | 1530 (892 to 2360) | 3290 (2230 to 4630) | 5760 (3360 to 8880) | 13 900 (9980 to 19 000) |
| Kidney | 935 (636 to 1300) | 2030 (1580 to 2540) | 5480 (4160 to 6940) | 10 900 (8690 to 13 200) |
| Liver | 616 (416 to 899) | 1370 (1020 to 1800) | 5080 (3920 to 6720) | 9960 (7910 to 12600) |
| Esophageal adenocarcinoma | 254 (149 to 398) | 543 (366 to 759) | 1580 (1140 to 2140) | 3020 (2240 to 3910) |
| Pancreatic | 294 (197 to 415) | 626 (464 to 817) | 1460 (1040 to 1920) | 3100 (2420 to 3840) |
| Colorectal | 308 (216 to 424) | 675 (518 to 860) | 1200 (897 to 1520) | 2390 (1870 to 2950) |
| Stomach (cardia) | 107 (61.4 to 172) | 230 (150 to 336) | 679 (473 to 1010) | 1330 (942 to 1870) |
| Multiple myeloma | 129 (86.8 to 193) | 278 (197 to 386) | 649 (436 to 932) | 1400 (1000 to 1870) |
| Thyroid | 171 (118 to 248) | 363 (270 to 494) | 611 (397 to 924) | 1340 (944 to 1890) |
| Advanced prostate | 79 (44 to 138) | 175 (114 to 261) | 380 (270 to 523) | 702 (509 to 957) |
| Gallbladder | 55 (39 to 76) | 118 (92 to 153) | 313 (233 to 406) | 674 (544 to 836) |
| Ovarian | 64 (37 to 103) | 135 (87 to 204) | 158 (65 to 291) | 397 (198 to 636) |
| Total | 6170 (4280 to 8460) | 13 300 (10 400 to 17 000) | 30 000 (21 600 to 39 300) | 65 000 (51 400 to 79 800) |
| Cancer deaths prevented, No. | ||||
| Liver | 350 (237 to 509) | 766 (568 to 1010) | 4440 (3420 to 5890) | 8690 (6880 to 11 100) |
| Breast (postmenopausal) | 183 (124 to 254) | 374 (283 to 492) | 3170 (1550 to 5570) | 7910 (4950 to 11 800) |
| Endometrial | 162 (97.1 to 242) | 359 (255 to 477) | 2100 (1230 to 3280) | 5230 (3760 to 6990) |
| Kidney | 149 (98.9 to 214) | 323 (239 to 417) | 2080 (1570 to 2670) | 4170 (3360 to 5070) |
| Esophageal adenocarcinoma | 135 (78.2 to 214) | 289 (194 to 404) | 1360 (987 to 1840) | 2580 (1910 to 3330) |
| Pancreatic | 185 (121 to 267) | 395 (288 to 522) | 1270 (903 to 1670) | 2700 (2120 to 3350) |
| Colorectal | 76 (53 to 105) | 165 (126 to 212) | 785 (592 to 1000) | 1560 (1220 to 1940) |
| Stomach (cardia) | 54 (30 to 86) | 116 (74 to 170) | 558 (392 to 834) | 1090 (768 to 1540) |
| Multiple myeloma | 39 (24 to 61) | 84 (59 to 122) | 389 (266 to 555) | 835 (618 to 1100) |
| Gallbladder | 31 (21 to 43) | 66 (51 to 86) | 263 (193 to 343) | 572 (459 to 707) |
| Advanced prostate | 12 (7 to 21) | 27 (17 to 42) | 170 (119 to 246) | 314 (223 to 439) |
| Ovarian | 22 (11 to 39) | 48 (28 to 76) | 114 (51 to 204) | 285 (154 to 430) |
| Thyroid | 2 (1 to 3) | 5 (4 to 7) | 25 (16 to 36) | 53 (36 to 73) |
| Total | 1430 (980 to 1940) | 3080 (2400 to 3840) | 17 100 (12 400 to 22 700) | 36 300 (28 700 to 44 900) |
| Life years gained | 2250 (1540 to 3100) | 4830 (3750 to 6060) | 78 300 (56 300 to 105 600) | 168 117 (132 000 to 209 000) |
| QALYs gained | 9640 (6740 to 13 600) | 20 800 (16 000 to 27 200) | 116 000 (83 800 to 153 000) | 252 000 (199 000 to 312 000) |
| Changes in health-related costs, cancer only, millions, $b,c | ||||
| Medical | −364 (−490 to −253) | −779 (−971 to −613) | −1600 (−2030 to −1190) | −3400 (−4080 to −2720) |
| Patient time | −18.0 (−25.3 to −12.2) | −38.1 (−49.6 to −29.0) | −114 (−151 to −80.7) | −252 (−311 to −200) |
| Productivity | −111 (−150 to −75.9) | −234 (−297 to −183) | −669 (−890 to −478) | −1480 (−1820 to −1170) |
| Policy implementation costs, millions, $b,c | ||||
| Government | 6.89 (5.96 to 8.30) | 6.88 (5.91 to 8.52) | 9.24 (7.18 to 12.8) | 9.30 (7.28 to 12.5) |
| Administration | 4.53 (4.29 to 4.76) | 4.53 (4.31 to 4.79) | 4.53 (4.29 to 4.80) | 4.53 (4.29 to 4.77) |
| Monitoring | 2.36 (1.41 to 3.74) | 2.34 (1.41 to 3.97) | 4.69 (2.75 to 8.29) | 4.77 (2.69 to 7.96) |
| Industry | 1660 (1410 to 1960) | 2090 (1820 to 2410) | 1660 (1410 to 1960) | 2540 (2240 to 2880) |
| Compliance | 1660 (1410 to 1960) | 1660 (1400 to 1960) | 1660 (1410 to 1960) | 1660 (1400 to 1970) |
| Reformulationd | NA | 427 (349 to 516) | NA | 869 (718 to 1061) |
| Net costs, cancer only, millions, $b,c,e | ||||
| Societal perspective | 1170 (871 to 1520) | 1050 (675 to 1410) | −704 (−1450 to −44.5) | −2570 (−3730 to −1450) |
| Health care perspective | −357 (−483 to −247) | −773 (−964 to −607) | −1590 (−2020 to −1180) | −3390 (−4070 to −2710) |
| ICER ($/QALY)f | ||||
| Societal perspective | 122 000 (70 600 to 207 000) | 51 400 (26 800 to 84 700) | Cost to saving | Cost to saving |
| Health care perspective | Cost to saving | Cost to saving | Cost to saving | Cost to saving |
Abbreviations: ICER, incremental cost-effectiveness ratio; UI, uncertainty interval; QALY, quality-adjusted life year.
a
Values are the median estimates (95% uncertainty intervals) of each distribution of 1000 simulations.
b
Health-related costs were inflated to 2015 US dollars using the Personal Health Care (PHC) index. Policy intervention costs were inflated to 2015 US dollars using the Consumer Price Index. Negative costs represent savings.
c
Costs are medians from 1000 simulations so may not add up to totals.
d
In the scenario considering policy association with consumer behavior alone, there is no policy cost for industry reformulation.
e
Net costs were calculated as policy costs minus health-related costs from reduced cancer burdens. Societal perspective includes health care cost, patient time costs, productivity costs, and policy implementation costs; government perspective included policy costs relevant to policy implementation and program monitoring and evaluation and medical costs.
f
ICER threshold was evaluated at $150 000/QALY.